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General NPI Number Information
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NPI Number | 1043633613
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Entity Type | Organization
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Legal Business Name | GOLDEN HEALTH CENTER INC
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Dates
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Enumeration Date | 02/01/2014
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Last Update Date | 02/01/2014
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Provider Practice Location Address
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Address Line | 7911 NW 72ND AVE STE 119
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City | MEDLEY
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State | FL
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Zip | 33166-2222
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Country | US
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Telephone | 305-885-5180
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Fax | 305-885-7119
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Provider Business Mailing Address
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Address Line | 7911 NW 72ND AVE STE 119
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City | MEDLEY
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State | FL
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Zip | 33166-2222
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Country | US
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Telephone | 305-885-5180
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Fax | 305-885-7119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL WILLIAM FORMISANO
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Credential | MD
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Telephone | 305-885-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME91614
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License Number State | FL
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